Impact of a centralised hospital admission system on the efficacy and efficiency of a geriatric functional recovery unit

• Published in: Revista española de geriatría y gerontología Vol. 55; no. 1; pp. 18 - 24
• Main Authors: Baztán Cortés, Juan José, Martínez Zujeros, Sergio, Garmendia Prieto, Blanca, Pérez Morillo, Patricia, Martínez Cervantes, Yolanda, Resino Luis, Cristina, Román Belmonte, Juan Manuel, Gómez Pavón, Javier, Pallardo Rodil, Beatriz, Socorro García, Alberto
• Format: Journal Article
• Language: Spanish
• Published: Spain 01.01.2020
• Subjects: Aged, 80 and over; Efficiency, Organizational; Female; Health Services for the Aged - organization & administration; Health Services for the Aged - statistics & numerical data; Hospital Departments - organization & administration; Humans; Institutionalization; Length of Stay; Male; Patient Admission - statistics & numerical data; Physical Functional Performance; Recovery of Function; Retrospective Studies; Geriatric rehabilitation; Efficiency; Paciente mayor; Eficiencia; Cuidados subagudos; Older patients; Efficacy; Sub-acute care; Rehabilitación geriátrica; Eficacia
• ISSN: 1578-1747
• DOI: 10.1016/j.regg.2019.08.008

To evaluate the influence of a change in the management of admissions on the activity and care outcomes of a Geriatric Functional Recovery Unit (GFRU). A retrospective observational study was conducted. Since 2000, the Hospital Central Cruz Roja GFRU has been collecting data grouped into periods of 4 years, except for the centralised admissions (September 2016-December 2018). The data collected on admission included the Red Cross Functional and Mental scales, the Barthel index, the main diagnosis of the functional decline (grouped into stroke, orthopaedic problem, and multifactorial immobility episodes), and comorbidity evaluated by the Charlson index. The following outcome variables were analysed: the overall and relative functional gain at discharge; length of hospital stay; the functional efficiency, discharges to nursing homes, and transfers to acute care units. An analysis was made of the relationship between the admissions from the centralised unit and the previous period (directly admission managed by GFRU), using multivariate analysis (linear regression for continuous outcome variables and logistic regression for the dichotomous ones), adjusted for admission variables. Patients admitted from the centralised unit showed a greater overall and relative functional gain (difference between both means: 3.49 points, 95% CI; 1.65-5.33, and 12.41%, 95% CI; 0.74-24.08, respectively), longer stay (12.92 days, 95% CI; 11.54-14.30) and lower efficiency (-0.36, 95% CI; -0.16 to -0.57), higher risk of institutionalisation (OR 1.61, 95% CI; 1.19-2.16), and transfers to acute care units (OR 3.16, 95% CI; 2.24-4.47). A centralised admissions system had an influence on the improvement of functional parameters in the patients, but with a longer length of hospital stay, and lower efficiency. Increases in institutionalisation at discharge and transfers to acute care units were also observed.